Case Management

Tip: Be sure the medical record contains all pertinent insurance information

Case Management Weekly, March 7, 2012

Discharge planners generally are not involved in the registration process, during which patients identify their insurance coverage. However, it is not uncommon for clinicians to be made aware of erroneous or missing insurance information.

For example, patients who are admitted through the emergency department are especially prone to errors or omissions in reporting insurance information. This can occur because the instability due to injuries or failure to locate their insurance card. This also can occur when patients are transferred from one acute care setting to another.

Some other examples of sources of erroneous insurance information include:

  • Patients whose coverage has changed recently (e.g., a patient who recently turned 65 and is eligible for Medicare)
  • Newborns not yet enrolled in their parent’s policy, especially when both parents work and have coverage; determining that parent’s policy is primary may depend of specific rules in each state
  • Young adults enrolled in a parent’s health plan whose marital status changes
  • Patients whose employers changed health plans during the same month as their admission
  • Patients with preexisting conditions

This week’s tip is adapted from Discharge Planning Guide: Tools for Compliance, Third Edition, published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace.

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